Evaluation of Chronic Kidney Disease Progression in Dogs With Therapeutic Management of Risk Factors

Abstract

This research was performed to describe the characteristics of the progression of naturally occurring chronic kidney disease (CKD) in dogs, together with the management of identified risk factors, following the International Renal Interest Society recommendations. Dogs diagnosed and staged with CKD, and with a longitudinal follow-up from the moment of diagnosis of up to a maximum of 730 days, were included. A total of 545 dogs that presented risk factors for the development of CKD were analyzed, out of which 36 met the inclusion criteria. Advanced age was identified in 80.6% of cases. Initiation risk factors were represented by inflammatory/infectious diseases, history of anesthetic-surgical procedures, heart disease, neoplasms, endocrinopathies, and exposure to nephrotoxic drugs. During the follow-up period, progression of CKD was identified in 47.2% of the cases, being more salient in advanced stages. Serum symmetric dimethyl arginine (SDMA) was the only glomerular filtration rate (GFR) marker which displayed differences among studied times during early stages of CKD, associated with the disease progression and decline of renal function. A significant difference between the survival curves in early and advanced CKD stages was observed. The factors related to decreased survival were hyperphosphatemia, anemia, and low body condition score (BCS). No differences were found between the presence of arterial hypertension and renal proteinuria and decreased survival. Furthermore, CKD diagnosis based on the persistent finding of abnormalities in early disease markers, such as serum symmetric dimethyl arginine increase and/or renal proteinuria, and timely therapeutic management of risk factors, allowed for CKD stabilization, reducing progression to advanced stages, and favoring higher survival rates.

The first study on urinary loss of iron and transferrin in association with proteinuria in dogs with chronic kidney disease

“…The prevalence of CKD was found in old age, which was due to renal impairment over time. Rather than old age, risk factors for CKD development were inflammatory/infectious diseases, history of anesthetic-surgical procedures, heart disease, neoplasm, endocrinopathies, and exposure to nephrotoxic drugs [ 2 ]. Canine vector-borne disease, particularly Ehrlichia spp., was associated with proteinuria [ 19 ].…”

“…The previous study in cats with CKD showed that both plasma CR and UPC ratio were associated with shorter renal survival time [ 3 , 4 ]. In dogs, slow disease progression and higher survival rates were related to persistent monitoring of SDMA, renal proteinuria, and timely therapeutic management [ 2 ]. The IRIS group categorized the severity of kidney disease and proteinuria in which the upper value of plasma CR in Stage III was 5.0 mg/dL, whereas proteinuria in dogs is considered when the UPC ratio is higher than 0.5 [ 21 ].…”

“…Most of the dogs in this study (33/37) had UPC ratio higher than 0.5. Besides proteinuria, another risk factor related to decreased survival rate is anemia [2]. In patients with diabetic nephropathy, after clinical and renal pathologic covariate adjustment, anemia was associated with adverse renal outcomes [22].…”

“…Both anemia and proteinuria were associated with decreased survival rate in dogs [ 1 , 2 ] and cats [ 3 , 4 ]. Non-regenerative anemia usually presents in the advanced stage of chronic kidney disease (CKD), which is associated with inadequate production of erythropoietin (EPO) [ 5 ] due to the loss of functional renal parenchyma.…”

Review of Chronic Kidney Disease and Comparison Between Humans, Dogs, and Cats

“…In addition, CKD is known to be more prevalent in women than men (Chronic Kidney Disease in the United States, 2021States, , 2021. Geriatric (older/aged) canines made up 80.6% of all CKD cases (Perini-Perera et al, 2021). In felines, about 63% of all cats older than 10 years of age (geriatric) have CKD (Bartges, 2012).…”